Individual
STEPHEN ALEX FASTEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
5042 DORSEY HALL DR STE 102, ELLICOTT CITY, MD 21042-7826
(410) 964-3020
Mailing address
5042 DORSEY HALL DR STE 102, ELLICOTT CITY, MD 21042-7826
(410) 964-3020
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
17491
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17491
MARYLAND STATE BOARD OF DENTAL EXAMINERS
MD
Enumeration date
07/09/2021
Last updated
07/09/2021
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